Gabapentin Use Linked to Increased Dementia Risk in Chronic Back Pain Patients

A cohort study of over 52,000 adults with chronic low back pain found that gabapentin prescriptions are associated with a significantly increased risk of dementia and mild cognitive impairment (MCI), particularly among non-elderly adults. Published in Regional Anesthesia & Pain Medicine, the study adds to growing concerns about the long-term neurological safety of gabapentin when prescribed for chronic pain rather than its approved indications.¹

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Gabapentin is FDA approved for partial seizures and postherpetic neuralgia, but has widespread off-label use for various chronic pain conditions, including back pain. The study raises red flags for clinicians and pharmacists alike, especially considering that gabapentin is often perceived as a safer alternative to opioids.²

Correlation With Frequency and Age

Using the TriNetX national database, researchers followed patients for 10 years and matched cohorts by demographics, comorbidities, and concurrent medications through propensity score matching. Patients prescribed gabapentin 6 or more times had a 29% increased risk of dementia and an 85% increased risk of MCI compared with those who never received the drug.

The association was even stronger in patients ages 35 to 64, with more than double the risk of dementia and MCI when prescribed gabapentin. Among patients with 12 or more prescriptions, the dementia risk rose to 40% higher than those prescribed gabapentin 3 to 11 times.

Younger adults, ages 18 to 34, did not show elevated cognitive risk with gabapentin use. In contrast, both middle-aged and elderly patients demonstrated a clear increase in incidence of dementia and MCI with higher exposure levels.^1-2

Pharmacist’s Role in Monitoring and Risk Mitigation

These findings underscore the importance of pharmacist involvement in long-term medication management for chronic pain patients. Gabapentin, although generally well tolerated, is known to cause adverse effects such as drowsiness, dizziness, blurred vision, and difficulty with coordination.³ In 2019, the FDA issued a warning about serious breathing problems when gabapentinoids are used concurrently with opioids or in patients with respiratory risk factors.⁴

Given the rising off-label use of gabapentin and its perception as a “safe” alternative to opioids, pharmacists should proactively assess cognitive risk, especially in non-elderly patients receiving chronic prescriptions. Medication therapy management programs may be especially useful in identifying patients at elevated risk and discussing de-escalation strategies with prescribers.¹

This study also calls attention to the need for cognitive monitoring tools in chronic pain care, a process in which pharmacists can play a vital role. Educating patients and caregivers about early signs of cognitive decline and maintaining accurate medication histories can help prevent avoidable adverse outcomes.

Limitations and Calls for Further Research

Although this study offers strong observational evidence, it cannot establish causation. The researchers noted that neither dose nor exact treatment duration was controlled for, and some coding variability could have affected diagnostic accuracy. Still, the use of a large national dataset, a 10-year follow-up, and robust matching methods add significant weight to the findings.¹

Some prior studies have failed to find a clear link between gabapentin and dementia, but others have raised similar concerns across different populations. The inconsistency underscores the need for further research, particularly prospective studies that control for dosage and assess neurocognitive outcomes over time.

Until such data are available, pharmacists and prescribers should remain cautious, particularly when managing younger adults on long-term gabapentin therapy. Given the dose- and frequency-related risk trends observed, deprescribing or dose minimization strategies may be warranted in some patient populations.¹

REFERENCES

1. Eghrari NB, Yazji IH, Yavari B, Van Acker GM, Kim CH. Risk of dementia following gabapentin prescription in chronic low back pain patients. Reg Anesth Pain Med. Published July 2, 2025. doi:10.1136/rapm-2025-106577 https://rapm.bmj.com/content/early/2025/07/02/rapm-2025-106577

2. George J. Study sheds new light on gabapentin risks. MedPage Today. Published July 10, 2025. https://www.medpagetoday.com/neurology/painmanagement/116456

3. Derry S, Bell RF, Straube S, et al. Pregabalin for neuropathic pain in adults. Cochrane Database Syst Rev. 2019;1(1):CD007076. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007076.pub3/full

4. FDA. FDA warns about serious breathing problems with seizure and nerve pain medicines gabapentin (Neurontin, Gralise, Horizant) and pregabalin (Lyrica, Lyrica CR). Published December 2019. https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-serious-breathing-problems-seizure-and-nerve-pain-medicines-gabapentin-neurontin